Making sense of the constant bombardment of information and sensory experience that all of us face requires the ability to determine the significance of events, and an elegant study suggests that the serotonin 2A receptor plays a critical role in determining significance. Many psychiatric conditions and human experiences are associated with the misattribution of meaning to events. For example, delusional disorder …
Low Dose Atypical Antipsychotics Are Better for Bipolar Depression
An analysis of several studies comparing low and high doses of atypical antipsychotics finds that low dose atypical antipsychotics are better for bipolar depression. In general, the therapeutic effects are the same, but side effects are significantly less with lower doses. The study reviewed the data from seven clinical trials of high and low doses of quetiapine (4 trials), cariprazine, lurasidone, and …
Poverty and Adversity Changes Brain Function
A remarkable study published in the journal Molecular Psychiatry identifies ways that the experience of poverty and adversity changes brain function. Specifically, the study finds that adolescents growing up in lower socioeconomic environments are more likely to have the gene that codes for the serotonin transporter protein methylated in a region that is associated with increased reactivity of the amygdala to threat. …
Atypical Antipsychotics with Mood Stabilizers
Many people with bipolar receive atypical antipsychotics with mood stabilizers. As in many areas of medicine, we have relatively little data about longer-term outcomes when people receive this combination. If an atypical antipsychotic is added to a mood stabilizer to control a manic episode, how long should that combination be prescribed? A recent study conducted by the Canadian Mood and …
UCSF Bipolar Education Group Starts Again
Dr. Descartes Li, an expert in Bipolar Disorder at UCSF runs an excellent 8 session program for people with bipolar who are interested in learning more. Here is the latest information about the group which starts at the end of February. The UCSF bipolar psychoeducational group starts on February 27, 2017. It runs for 8 sessions, Mondays 12pm to 115pm. …
Antidepressant Response Linked to Norepinephrine Transporter Genotype
A large study of patients treated with venlafaxine found that antidepressant response was linked to the norepinephrine transporter (NET) genotype. The study looked at response in a sample of 350 individuals over the age of 60 with severe depression (MADRS greater than or equal to 15) who were treated with venlafaxine up to a dose of 300 mg a day. …
Controlled Substance Refills
Controlled substances are medications with a potential for abuse or misuse. They are often, also, medications that have powerful effects on brain function. Common controlled substances that doctors prescribe include: Narcotic pain medications (Demerol, Norco, Tyco, etcetera) Stimulant medications (Adderall, Ritalin, Concerta, etcetera) Benzodiazepines and similar sedating and anti-anxiety medications (Xanax, Valium, Ativan, Ambien, etcetera) Testosterone and some other hormone …
TMS for Depression – Repeat Treatment
TMS is an expensive, time-consuming, but effective treatment for depression, but how should it be used for treating patients with chronic depression? And for those who have an initial positive response when should we consider another course of TMS (known as reintroduction therapy)? These are all questions which have not been adequately addressed in the research literature. A study published in …
Pregnancy and Bipolar
Pregnancy Outcomes in Women with Bipolar Disorder A recent review of the topic of bipolar and pregnancy from the MGH Center For Women’s Mental Health on November 14, 2016 sparked us to write this post. When talking with a bipolar woman contemplating pregnancy there are two considerations: what additional risks to the unborn child are created by taking psychiatric medication and what risks exist …
Insomnia Relief
How to find insomnia relief is a question that many people we work with struggle with. A recent editorial in JAMA Psychiatry and the accompanying research article suggests that the online program that we’ve been recommending to our patients for years (SHUTi) is the treatment of choice for insomnia. We have been extremely pleased with the results from this program which can …